Provider Demographics
NPI:1275524985
Name:VAN LANCKER, JANINE (MD)
Entity Type:Individual
Prefix:
First Name:JANINE
Middle Name:
Last Name:VAN LANCKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 QUEBEC ST. N.W.
Mailing Address - Street 2:#422N
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008
Mailing Address - Country:US
Mailing Address - Phone:312-399-8678
Mailing Address - Fax:301-470-3757
Practice Address - Street 1:2150 PENNSYLVANIA AVE NW
Practice Address - Street 2:SUITE G-402
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-3201
Practice Address - Country:US
Practice Address - Phone:202-741-2771
Practice Address - Fax:202-741-2775
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0062976207R00000X
DCMD036731207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I39489Medicare UPIN
017714I06Medicare UPIN